Provider Demographics
NPI:1396399291
Name:FIFER, LISA R (OT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:R
Last Name:FIFER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16405 202ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98077-9413
Mailing Address - Country:US
Mailing Address - Phone:206-650-3066
Mailing Address - Fax:
Practice Address - Street 1:733 7TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5657
Practice Address - Country:US
Practice Address - Phone:206-717-8161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist